Last week a news story made its rounds on internet sites and blogs about a New York State EMT who had been suspended for six weeks and then quit his volunteer department for what many called “doing the right thing.”  If you have not seen the article, feel free to follow this link.  Otherwise I’ll give you the Cliff Notes version of the story: Twenty year-old Stephen Sawyer, a member of the Ellenville First Aid and Rescue Squad was at his station alone when a call came in for a four year-old having a seizure.  Sawyer, who is one year under the Squad’s policy stated age to drive but is an employee at a private EMS service in the area was the only EMT available that day when the paramedic on scene “called for an ambulance” for transport.  Unable to find any available mutual aid unit to respond to the call, Sawyer decided to take matters into his own hands.  Sawyer, referred to in one article as a “squad leader,” a member of the Squad’s communications committee and an advisor to their Youth Squad who presumably had knowledge of his department’s policy did what he “felt he had to do” and violated the 21+ driving policy, responded in an ambulance, and transported the patient to a local ER. The response of the Ellenville First Aid and Rescue Squad’s board of directors was to suspend Sawyer for 60 days.  Sawyer then resigned from the squad on the spot. In another article that interviews the Squad’s captain Mr. John Gavaris, the captain states the under normal circumstances, Sawyer might not have been suspended if not for his previous disciplinary record which was not focused on in greater detail.  The response both from his community and the social media EMS community was one of “online outrage.”  People felt that the 60 day suspension was too harsh and called from Sawyer to be reinstated immediately.  Although the argument could be made that 60 days is a pretty harsh sentence, I have to stand with the Squad on this one.  They made the right call. Like it or not, policies exist.  Policies have to exist.  They are what give...

This post can also be found at The EMS Leader I remember the first time that I watched Mother, Juggs, and Speed and saw Larry Hagman walk into F&B Ambulance for the first time, and put his resume on the table.  After barely even looking at his resume, Mr. Fishbine hired him, with barely an interview.  No selection process, no nothing.  A guy with a card, getting a job.  Many might see that as a Hollywood shortcut, but sadly in my experience in many places, especially the private industry, the vetting of prospective employees is far too brief.  You then are introduced to the rest of the “team” at F&B ambulance which includes the veteran, Mother.  The guy who is really in charge, seemingly because he is the guy who has been there the longest. I point out this great 70’s movie because it was actually the first exposure to EMS that many people who are my age had.  Sure, I’m 35, and this movie came out the same year that i was born, but even nineteen years later when I was a freshman in college we watched it as part of one of our EMS management classes.  Although my two full time jobs have been with pretty large, put together organizations I have plenty of friends who have and do work in the smaller mom and pop sized section of the industry.  I have heard plenty of stories about people being sent out on the street as fast as they come in the door.  It is time for EMS to take a good look at their career ladder and hiring processes.   First though, we need, as an industry, to decide who we want and decide what a career ladder really entails.  Should the evolution of BLS to ALS really be considered part of that ladder, or is it possible to move “up” the chain in EMS without having a paramedic patch on your sleeve? Can a BLS provider be qualified to be a section leader on a major incident?  Can they receive and utilize the training necessary to deal with day to day personnel and scheduling issues that always seem to pop up?  Far too...

I am the kind of person that craves numbers.  I’l comb the sports section of any website or newspaper looking for the line scores from baseball games, and the statistical leaders for the NFL in a given week.  I’ve always spoken in numbers.  I think that they are a great way to measure effectiveness in EMS. We have gotten to be very good at tracking response times.  We have defined methods of how to do it, and often when a system decides on a tracking method, we stick with it.  The same cannot be said, however, for tracking ROSC rates.  While everyone in EMS can agree on what a ROSC is, we struggle in agreeing upon what a ROSC is not.  Some systems omit traumatic arrests from their ROSC numbers.  Others do not count field pronouncements.  Personally, I feel that if a provider puts his or her hands on a patient’s chest with the intention of doing CPR, then that call should count positively or negatively against their ROSC rate depending on the outcome. I feel, however, that there are a few other statistics that we as EMS systems should be looking at on a regular basis.  Here are a few examples: PMD input vs. paramedic impression – Keeping with the theory that an EMS system is responsible for a patient from the moment the phone is picked up to the moment that they turn the patient over to a higher level provider at a hospital, I feel that tracking the effectiveness of PMD is incredible important.  We need to recognized that being as accurate as possible from step one is extremely important in providing the correct resources for a given EMS call. Last month, I wrote a post about the recoding of shootings and stabbings in Oakland, California and shared my thoughts as to what I felt that the problem was.  In the original article I referenced many were critical of Priority Medical Dispatch.  Over the years, my opinion of it has fluctuated.  I have seen it work tremendously well, and I have seen it be the downfall of an EMS system.  The bottom line though is the industry is moving away from...

This post can also be found at The EMS leader hosted by EMS Blogs. Last week, we talked about the problems and challenges presented to us by the young work force that some EMS leaders are having a difficult time adapting to dealing with.  I have been giving a great deal of thought to what the solution to this problem is, and I cannot help but feel that it is evidence of a need to change how we train.  No, I am not talking about adding hours to an EMT class, or teaching CEU classes on how to be what some would consider a better employee, I am talking instead about changing how we utilize our field trainers. Any EMS service that cares about what happens in the street, and cares about how their patients and customers are treated has established some form of a field training program, usually staffed by experienced employees who are initially shadowed by and then later evaluate the new EMT or paramedic to make sure that they are ready to be cut loose and released to practice their trade on the unsuspecting public.  I have seen many different methods used over the years from a group teaching approach, or a one on one tactic where the new employee spends all of their time with one FTO.  Others use a system where the “student” is bounced around from preceptor to preceptor to prevent them from picking up just one person’s bad habits.  They each have their own merits and shortcomings, but the real testament to their effectiveness is what we do with our FTO’s and their new employees once all of their requirements have been met. Far too often in too many systems, employees finish up their precepting time and they are given the “okay” to hit the streets.  From there, they are on their own.  They might get a follow up six months or a year out to say “good job, keep it up” but beyond that the contact is minimal.  Maybe what we need is to establish a stronger bond and relationship between field trainers and new paramedics or EMTs and instead utilize them as mentors. When there...

This post can also by found at The EMS Leader hosted by EMS Blogs. One of the unfortunate things about having a new job is I fall at the bottom of the list when it comes to vacation time.  With the days off that I could get I was forced to miss the last day of EMS Expo in Las Vegas this year.  While following on Twitter though, I caught Greg Friese commenting on a panel discussion by members of the National EMS Management Association (NEMSMA for short) during a program called “The EMS Situation Room: NEMSMA Administrators, Managers, and Chiefs Forum.”  To sum up the discussion simply, the focus of the forum turned to what we will refer to as the “youth movement” in EMS today. As a former supervisor for a service that likes to populate itself with lesser experienced individuals, it has become clear that the work force is changing, and it seems like some of the “old guard” is having difficulty dealing with a lot of the new attitudes and changing needs of the work force.  The entire topic is something that has certainly raised my eyebrow, and it is really something that we need to look at from the first day of EMT class moving forward to someone’s last day with an EMS service. When I was in Washington DC this year for EMS Today, I was on a podcast hosted by Dave Aber where the panel included two of my paramedic instructors from Springfield College.  One of the main topics of discussion was the changes that they had witnessed in their student population over the years.  Fifteen or twenty years ago, when paramedicine was still in its infant stages, most of the student body was made up of people who had been practicing EMS for a number of years.  The vast majority of paramedic students were street smart, seasoned adult learners.  We staffed ourselves from the inside using people who were already integrated into the system and had a strong foundation and framework to help them through class.  As time has gone on though, both the work force and the pool of students have gotten younger and less...

I have been giving some thought to the recent events in Springfield involving an ambulance being struck by bullets, and a rather real looking BB gun being pulled on a tech in the back of an ambulance.  That, along with the law passed this year in Delaware got me thinking, and i figured I would pose a question of the readers. If an EMT or paramedic is assaulted, where should the responsibility of filing charges fall?  Should services have a zero tolerance policy regarding violence against their employees?  Should they be encouraged to strongly advocate for their employees with law enforcement and encourage their people to file charges, assisting them along the way?  Or should they take a hands off approach and leave the decision and procedure of pressing charges to their individual employee? So, what do you...

EMS is currently at a major crossroads as an industry.  Across the country requirements to become a paramedic are becoming loftier, and rightfully so.  In order to properly care for each patient we encounter, we need to be at our best, and the route to that is through training and that bar is being raised.  More education eventually should mean more pay, and some in the private sector are starting to realize that. This is evident from the recent well publicized labor dispute in Buffalo, New York and their eventual 10 hour work stoppage followed by a contract settlement.  From the publicity I have seen regarding those negotiations and others I have more intimate knowledge of, it leaves little to the imagination as to what is most important to EMS professionals: pay and benefits.  I know, that seems like a slam dunk, no brainer, but it also seems clear that at least in the private sector, purse strings are becoming tighter, and benefit packages are less and less appealing.  It’s quite the conundrum, actually.  Increasing educational requirements are driving paramedicine towards being a career, yet employers are still far too often looking at employees with the expectation that they have a job, and there is a divide the size of the Grand Canyon between the two. Now, the jury is still out for me on work actions such as strikes.  I do not really know if they truly follow the “spirit” of our profession and seem to do more of a disservice to the community than they do benefit the worker, but that is a debate for another time.  The fact remains that they happen, and there is certainly reason behind them, as evident by the Buffalo, NY Rural Metro incident. While the private sector is just one of a number of EMS models, it is quite often the quickest path of entry into the industry and employs more EMTs and paramedics than any other model, so discussing the big kid on the block is extremely important.  With health care taking on a huge for profit presence in the economic world, everyone wants their piece and if some of the bigger players want to...

A little over a year ago, I tackled the concept of “skill dilution” and its validity as a statement, and reality in the field.  My perception at that time was that a more important component to focus on instead of skill dilution was education for our paramedics.  While I still stand by the concept that we need to better prepare our medics for what they will encounter when they hit the streets, my views of skill dilution have changed a bit. The EMS system in Massachusetts is quite different from the one that I currently working in.  I know, that is no shocking revelation since it has been said to exhaustion that “if you’ve seen one EMS system, you’ve seen one EMS system” but I find the uniqueness of my current situation interesting in comparison to where I was.  The easiest way to look at it is by evaluating both environments on a county-wide basis. On a common day, Hampden County, Massachusetts has approximately 25 paramedic level ambulances protecting its citizens.  They respond to emergencies for the most part regardless of the complaint.  Everyone gets the same opportunity to have the most advanced care available to a sick person regardless of what the caller told the dispatcher, or what the Emergency Medical Dispatch (EMD) code says is the appropriate response for that incident.  Do you have a splinter?  You’ll most likely get a paramedic.  Are you having chest pain?  You’ll most likely get a paramedic.  That paramedic’s partner, however, could be an EMT, an intermediate, or even a paramedic.  All that Massachusetts requires is one paramedic to make an ambulance an ALS level ambulance. In the county I work in now, there are nine paramedic units for the entire county.  None of us transport.  We respond to only ALS level calls as determined by EMD codes, and we are supplemented by approximately 30 BLS level ambulances.  I do not know the exact number, but to me, that “feels” about right.  Every paramedic unit is staffed with two paramedics, and the state requires that each ALS appropriate 9-1-1 call gets at least two paramedics. According to the 2010 census (and Wikipedia), there were about 463,000...

It is not difficult to figure out where many of us out here in the blogging world get our material from.  Some of it is derived from frustration, and some of it from lessons we have learned that we feel the need to pass on to others.  With this blog more than three years old, it doesn’t take a rocket scientist to figure out where some of my material comes from.  It is from my past, and from MY experiences in the years that I worked for AMR in Springfield and frankly, I could not be more proud to say that Springfield was where I spent the first twelve years of my career. In a meeting Thursday night held by the City of Springfield’s EMS Commission, the five commissioners voted unanimously to recommend American Medical Response to handle the 9-1-1 contract in their city for the next five years.  Last night I posted on my personal Facebook page that this decision was a “. . . much deserved and expected victory” for the staff at AMR Springfield, and now that I look back on it, and look back on the decision, I do not feel that statement fully describes the impact of the EMS Commission’s recommendation to the city. The real winners in this situation are the citizens on Springfield because they are getting the best care that they possibly could by having the paramedics and EMTs of AMR Springfield to respond to their emergencies.  AMR has had the opportunity to be in the lime light a few times in the past couple of years with the tornado of 2011 and the gas explosion of 2012 to name just a few, and while those calls were very high profile and visible, they barely make up a chapter in the story of AMR Springfield. The things that are really important are the things that happen every day.  It is not the multitude of trucks that I had sitting in our staging area on Worthington St that night, it was the other ambulances that were out still answering the “routine” emergencies that made the difference.  It was not just our crews going to door to door...

The WGGB story that I wrote about last week and some recent discussions with a few friends have gotten me thinking about the common media response that EMS services seem to have.  While there are some services out there that are leading the way and showing us what we need to do when it comes to public relations and the utilization of a public information officer, more times than not the attitude is taken that “no news it good news.”  That could not be farther from the truth.  No news means that you, as a community partner, are not doing your job. Not a month goes by that there is not some news story that an EMS service could add their input to.  For example, did you know that February was Heart Awareness Month?  What a great opportunity for paramedics and their leaders to talk about what a person should do when they start having chest pain at home. Another great two prong approach is to share the accomplishments and milestones of your service and your personnel with the community.  Do you have someone who has been working for the service for 25 years?  Write a press release about it, and invite the local paper to come interview them.  Have you gotten a new cutting edge piece of equipment or a new state of the art ambulance?  Invite a TV station over for a tour a demonstration.  Not only does the community get to see what you are up to, but you get to build a positive relationship with the press, and your people know that you are proud of them and want them to be in the spotlight. With so many media opportunities out there, everyone has a chance to talk about whatever they want.  Look at what I am doing right now.  I am blogging, and people are reading it and while not every entry into the media world whether it is social or traditional requires a response, an EMS service needs to be ready to say something besides “no comment.” If people do not know what happens when they call 9-1-1, that is the service’s fault, not the public.  They should...